Create a new section of Subtitle 17A of KRS Chapter 304 to define the terms "contracted pharmacy," "drug product reimbursement," and "pharmacy benefit manager"; require a pharmacy benefit manager to include the methodology used to calculate drug product reimbursements; establish certain requirements when a maximum allowable cost is used to determine a drug product reimbursement, including information identifying the national drug pricing compendia or source used to obtain the drug price, making the list of drugs subject to the MAC, and reviewing and making adjustments to the maximum allowable cost at least once per week; make those weekly updates available to contracted pharmacies; and provide a process for the MAC to be appealed.

Proposed Amendments

Delete original provisions; create a new section of Subtitle 17A of KRS Chapter 304 to define terms, including the definition of "contracted pharmacy" that requires that the contracted pharmacy be located in Kentucky; require contracts between PBMs and pharmacies to include sources used by the PBM to calculate the drug product reimbursement; require a process that will appeal, investigate, and resolve disputes; specify length of time to raise an appeal and to investigate and resolve it; require that the national drug code of a drug that can be purchased by the contracted pharmacy at or below the MAC cost be provided when an appeal is denied, require that a process for retroactive reimbursements be included in PBM and pharmacy contracts within one year; require the PBM to include national drug pricing compendia or sources used to obtain drug price data when a MAC is established for a drug; require the drugs subject to MAC and the MAC for each drug be provided to each contracted pharmacy; require review and necessary adjustments to the MAC at least every 14 days; require weekly updates to the list of drugs subject to the MAC.

Retain original provisions, except remove the requirement to disclose the methodology to determine the MAC, extend the requirement to review the MAC to once every two weeks, require appeals to be completed within 10 days, and require that the national drug code of a drug that can be purchased by the contracted pharmacy at or below the MAC cost be provided when an appeal is denied.

Retain original provisions, except remove the requirement to disclose the methodology to determine the MAC; extend the requirement to review the MAC to once every two weeks; require appeals to be completed within 10 days; require that the national drug code of a drug that can be purchased by the contracted pharmacy at or below the MAC cost be provided when an appeal is denied.